Risk Adjustment

Risk Adjustment Solution for Medicare Advantage Plans

Medicare reimbursement rates and bonuses are the lifeblood of every Medicare Advantage plan. Finding medical records for the right members, identifying missed diagnoses and accurately reporting those additional HCCs in RAPS filings typically result in Millions of Dollars of incremental revenue for a Medicare Advantage plan.

There are challenges to striking a balance between submitting what can be legitimately claimed and avoiding penalties for unsupported diagnoses while pursuing medical records that are likely to yield additional revenue.

HDVI’s mission is to get every relevant medical record possible, code them correctly, and deliver reliable and auditable results.

HDVI provides a solution that answers this challenge: unrivalled accuracy in collection and coding, backed by performance guarantees. In addition, HDVI offers a whole set of coding and analytics options, which ensure that the results are exactly what our clients have been looking for. This may include coding diagnoses other than the ones supporting HCCs (anticipating chases in the model, using information for care management, etc.), smart and logic-driven member suspect identification data comparisons or the use of identified diagnoses as a baseline.

In addition MRCS provides a built-in audit defense tool, which saves significant resources and eliminates uncertainty during a RADV audit. As with other offerings, HDVI’s mission is to get every relevant medical record possible, coding them correctly and reliability delivering auditable results.